[Federal Register Volume 61, Number 158 (Wednesday, August 14, 1996)]
[Pages 42257-42258]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-20668]


Health Care Financing Administration

Proposals Submitted for Collection of Public Comment: Submission 
for OMB Review

    In compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Health Care Financing 
Administration (HCFA), Department of Health and Human Services, has 
submitted to the Office of Management and Budget (OMB) the following 
proposals for the collection of information. Interested persons are 
invited to send comments regarding this burden estimate or any other 
aspect of this collection of information, including any of the 
following subjects: (1) The necessity and utility of the proposed 
information collection for the proper performance of the agency's 
functions; (2) the accuracy of the estimated burden; (3) ways to 
enhance the quality, utility, and clarity of the information to be 
collected; and (4) the use of automated collection techniques or other 
forms of information technology to minimize the information collection 
    1. HCFA-R-107--Type of Request: Extension of a currently approved 
collection; Title of Information Collection: Medicaid--Determining 
Liability of Third Parties and supporting regulation 42 CFR 433.138; 
Form No.: HCFA-R-0107; Use: The information collected from Medicaid 
applicants and recipients as well as from State and local agencies is 
necessary to determine the legal liability of third parties to pay for 
medical services in lieu of Medicaid payment. Regulation 42 CFR 
4333.138 requires the increase of third party resources to improve 
program efficiencies and reduce Medicaid expenditures; Frequency: On 
occasion; Affected Public: Federal Government and State, local, or 
tribal government; Number of Respondents: Varies; Total Annual 
Responses: Varies; Total Annual Hours: 171,165.
    2. HCFA-R-188--Type of Information Collection Request: New 
collection; Title of Information Collection: Federally Qualified Health 
Center (FQHC) Survey; Form No.: HCFA-R-188; Use: This survey is needed 
and will be used by HCFA to evaluate the FQHC Medicare benefit. 
Respondents will be all Medicare certified FQHC's. Frequency: On 
occasion; Affected Public: Not-for-profit institutions, and business or 
other for-profit; Number of Respondents: 1,489; Total Annual Responses: 
1,489; Total Annual Hours Requested: 496.
    3. HCFA-R-193--Type of Information Collection Request: Existing 
collection in use without an OMB control number; Title of Information 
Collection: An Important Message from Medicare; Form No.: HCFA-R-193; 
Use: Hospitals participating in the Medicare program have agreed to 
distribute ``An Important Message from Medicare'' to beneficiaries 
during each admission. Receiving this information will provide the 
beneficiary with some ability to participate and/or initiate 
discussions concerning decisions affecting Medicare coverage or payment 
and about his or her appeal rights in response to any hospital's notice 
to the effect that Medicare will no longer cover continued care in the 
hospital. Recordkeeping: As needed; Affected Public: Individuals or 
Households, Business or other for-profit; Not-for-profit institutions, 
Federal Government, and State, Local or Tribal Government; Number of 
Respondents: 6,700; Total Annual Responses: 11,000,000; Total Annual 
Hours Requested: 183,333.
    4. HCFA-R-194--Type of Information Collection Request: New 
collection; Title of Information Collection: Medicare Disproportionate 

[[Page 42258]]

Adjustment Procedure and Criteria; Form No.: HCFA-R-194; Use: 
Regulation sets up an alternative process for hospitals that choose to 
have their disproportionate share adjustment statistics calculated 
based on their cost reporting periods rather than the Federal fiscal 
year. Frequency: On occasion; Affected Public: Business or other for-
profit, and Not-for-profit institutions; Number of Respondents: 100; 
Total Annual Responses: 100; Total Annual Hours Requested: 100.
    5. HCFA-319--Type of Request: Reinstatement, without change, of a 
previously approved collection for which approval has expired; Title of 
Information Collection: State Medicaid Eligibility Quality Control 
Sample Selection Lists; Form No.: HCFA-319; Use: The State MEQC 
sampling list is necessary for regional offices to control and track 
State MEQC reviews. The sample selection lists contain identifying 
information on Medicaid beneficiaries. Frequency: Monthly; Affected 
Public: State, local, or tribal government; Number of Respondents: 55; 
Total Annual Hours: 5,280.
    6. HCFA-856--Type of Information Collection Request: New 
Collection; Title of Information Collection: National Payer Identifier 
(PAYER-ID); Form No.: HCFA-856; Use: The PAYER-ID will allow payers of 
health care claims to be identified by a unique numeric identifier. 
PAYER-ID numbers will be assigned, but not limited to the following 
groups: Medicare, Medicaid, VA, Public Health Service, large employers 
and unions, HMOs, large insurers, etc.; Frequency: One time 
(reporting); Affected Public: Not for profit institutions, business or 
other for profit, Federal government, State, local or tribal 
government; Number of Respondents: 85,000; Total Annual Responses: 
85,000. Total Annual Hours: 85,000.
    To request copies of the proposed paperwork collection referenced 
above, E-mail your request, including your address, to 
P[email protected], or call the Reports Clearance Office on (410) 786-
4193. Written comments and recommendations for the proposed information 
collections should be sent within 30 days of this notice directly to 
the OMB Desk Officer designated at the following address: OMB Human 
Resources and Housing Branch, Attention: Allison Eydt, New Executive 
Office Building, Room 10235, Washington, D.C. 20503.

    Dated: August 6, 1996.
Edwin J. Glatzel,
Director, Management Planning and Analysis Staff, Office of Financial 
and Human Resources.
[FR Doc. 96-20668 Filed 8-13-96; 8:45 am]